Claim total
$843.43
base $93.83 · payer covered $793.43
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2005-05-30
- Stop
- 2005-05-30
The parties
- Patient
- patient Angelica Yetta Goyette
- Provider
- provider Lara O'Kon
- Care site
- care site FAMILY LINK SOCIAL SERVICES
- Payer
- payer Medicaid
Record id
2c2210e3-e57b-0933-9e18-ce06fe83370a